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Surge Tool Kit and Facility Checklist

Public Health Emergency Preparedness

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Facility Checklist

Administration/Exterior (continued)

Date: ____________ Location: _______________________ Team member: __________________________

Building Exterior (Outside of facility, including condition of external structure.)

Observations

General Structural Condition

Missing structural items (doors, windows, etc.):
Signs of illegal entry/use:

Accessibility

Walk-in entrances:
Signage:
Ambulance access:
Loading dock:
Fire escape and other means of egress:

Portables feasibility (adequate space, access for feeds, exhaust)

Generator:
Chiller:
Boiler:

Decontamination set-up potential

Space:
Ability to create secure zone:
Water source:
Water containment ability:

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